Carlos Monteiro's ultra-processing commentary on shared meals is now on-line

John Waterlow (left), whose life and work was celebrated last month, and
Michael Latham (right), commemorated inWorld Nutrition this month

The life and work of Michael Latham is the subject of a series of eulogies published in World Nutrition this month.

We published a short appreciation of John Waterlow in last November's home page. Last month a special meeting was held at the London School of Hygiene and Tropical Medicine to honour John Waterlow, following leading obituaries in The Guardian, The Independent, and The Daily Telegraph. The tribute that follows is by David Picou, John Waterlow's successor as head of the Tropical Metabolism Research Unit in the West Indies.

Professor John C Waterlow CMG FRS FRCP DSc

To say that my life has been influenced by John Waterlow would be a gross understatement. He trained me as a scientist, researcher and writer. Whatever leadership qualities I possess, I owe to him. He was my mentor and lifelong friend of 51 years. This tribute acknowledges my debt to him and tries to convey what a great and unique person was John Conrad Waterlow.

In 1945 he arrived in the Caribbean on a mission for the British Colonial Office to find out why so many young children were dying of malnutrition there. His first stop was in Guyana, then called British Guiana, where he worked among the Akowoio Indians living in the Pakaraima mountains on the borders of Venezuela and Brazil.

Later while in Jamaica he met with members of the Irvine Commission who were laying plans for a new university in the West Indies. Members included Hugh Springer and Philip Sherlock who made a strong impression on John, in stark contrast to the racial discrimination he had witnessed in the three Caribbean colonies. He then and there decided he wanted to be part of that bold university experiment to create a truly multiracial community of scholars working for the betterment of West Indian populations. John maintained a lifelong friendship with his newfound friends who were both to play significant roles in the creation of the University of the West Indies (UWI), and who were awarded knighthoods.

Five years later in 1950 he returned to Jamaica, where he negotiated a proposal for a shared appointment at the new university and the British Medical Research Council, which both institutions accepted. He lectured in physiology and continued his studies on the fatty liver of malnourished children. It was during this period that I had my first informal encounter with him. He had invited all the medical students to a party at his home, and as I entered I was handed a bottle of rum which I was instructed to share with others. Several bottles were given out that night and the party turned out to be a most memorable one. It would be many years before our paths crossed again.

Strengthening the Caribbean

After three years in the West Indies he returned to England, but soon went back to Jamaica. He said: 'There is so much still to do here, much more than I can do on my own. I shall put it to the MRC that there should be a unit in Jamaica, working initially on malnutrition… Therefore I proposed the name 'Tropical Metabolism Research Unit' (1). The international renown and success of this institution in research in human nutrition, and its continuing role as a centre of excellence under the capable leadership of Professor Terrence Forrester, attest to the vision, foresight and leadership of its founder.

I then went to the US and might have taken a job there, but in April 1959 fate stepped in, in the form of John Waterlow, who invited me to lunch in Atlantic City. There he offered me a one year appointment at the TMRU starting as soon as possible. I quickly accepted and returned to Jamaica much sooner than I had expected to. Little did I know that the initial one year contract would extend to 21 years with the MRC (until 1970) and the UWI (until 1980).

In 1959 I was the sole MRC staff member of West Indian origin at the Unit, until 1961when Dr. George (later Sir George) Alleyne, another University College of the West Indies graduate, class of 1957, from Barbados, joined. Our appointment as MRC staff at the TMRU was apparently a first for MRC, since at the other two MRC Units in the Gambia and Uganda there were no local MRC staff appointments. However, our terms and conditions of service were not the same as for other MRC staff who were all from the UK. Dr. Waterlow considered this a blatant injustice. Although he took this matter up to the highest level, it was never rectified. Another major difference with the MRC was that he had felt from the beginning that 'the Unit should contribute to the intellectual development of the region'(1).

John Waterlow was gifted in many ways. In the laboratory, he was able to construct an instrument if it was not available commercially. Thus he constructed and developed a micro-respirometer based on the Cartesian diver apparatus that was 1,000 times as sensitive as the conventional Warburg apparatus. This enabled him to measure enzyme activity in a few milligrams of tissue. He also constructed a quartz fibre torsion micro-balance sensitive to about two micrograms, to weigh liver biopsy specimens. He taught us how to make and calibrate micropipettes and I made and used a 57 microlitre one for many years. Under his tutelage, I constructed a Geiger counter and sample holder for my work on albumin metabolism. Fifty years ago, none of these items were available commercially. This training was put to good use when I was able to do routine maintenance on a mass spectrometer that was used in all my stable isotope work.

Highest standards of scholarship

Although John Waterlow assigned research projects to new staff, he encouraged us to think on our own and to develop our own ideas and areas of research. His criticism was always constructive, never destructive. He suggested, rather than instructed. He also wrote scientific papers with clarity, economy of prose and a relentless flow of logic. It was humbling to submit one's draft of a paper and see it transformed into an elegant presentation. I observed how he engaged with his juniors, with impeccable politeness and genuine sincerity; never belittling nor bullying. He encouraged and facilitated his junior staff to present their work at regional and international conferences, but not before they presented to the Unit where presentations were thoroughly critiqued. At conferences, our work was always examined carefully but well received as it had the 'TMRU/Waterlow' stamp on it. He afforded promising junior staff every opportunity to advance in their careers.

He had a passion for hiking and spent many a holiday hiking in Italy and Greece. He combined scientific enquiry with hiking during the three expeditions he mounted to the Colombian Andes. Other Unit members accompanied him, but I politely declined and was left in charge of the Unit. There were also professional climbers and an enormous amount of equipment involved, and many months of preparations for the climb and the scientific experiments preceded the event. At one of these Andes expeditions which examined the causes of altitude sickness, he made himself potassium-deficient before the climb and on reaching high altitude became progressively sick, oedematous and finally comatose. He was quickly removed to base camp and given potassium tablets when he recovered (1).

Growing independence

I would now like to dwell on Professor Waterlow's involvement with the Caribbean Health Research Council (CHRC) (2,3). The TMRU was established at the University College of the West Indies (UCWI) in October 1954 with John Waterlow as its first Director. It became operational in 1958. In 1955 the predecessor to the CHRC, the Standing Advisory Committee for Medical Research in the British Caribbean (SAC), was formed. Its terms of reference were:

'To advise [the Secretary of State for the Colonies] on the needs for medical research in Jamaica, Trinidad, British Guiana, Barbados, the Leeward Islands, the Windward Islands and British Honduras; to advise on the means for ensuring that the results of research are applied in practice; and to keep under review the facilities for inter-territorial collaboration in medical research'.

John Waterlow was appointed SAC Scientific Secretary and was the first of a continuous line of TMRU Directors who have held this post. In 1972 the Conference of Ministers Responsible for Health of the Commonwealth Caribbean eventually accepted his proposal for the transition of the SAC to the Commonwealth Caribbean Medical Research Council (CCMRC) with the following objectives:

'To promote and coordinate Medical Research in the Commonwealth Caribbean, and To provide advice to governments on matters relating to medical Research, including the needs and priorities appropriate to the area'.

This historic event was the fulfillment of a prediction made by the Chief Minister of Jamaica Norman Manley in his opening address at the inauguration of the SAC in 1956:

'It is, I believe, the sign and promise of the creation of a Caribbean Medical Research Council which manifestly we need and which could be projected at no more appropriate time than in this year when at long last the majority of the units of the British Caribbean area have resolved to come together in a federal structure'.

The evolution to the Caribbean Health Research Council took place in 1997. The word 'Commonwealth' was removed in recognition of the fact that residents from the Dutch and French West Indies had been participating in our scientific and business meetings for decades. The word 'Medical' was replaced by 'Health' because its activities embrace the broad range of health-related research rather than just medical research.

John Waterlow sometimes recalled how the famous Jamaican Dr. Cicely Williams (of kwashiorkor fame) would visit the TMRU from time to time and ask: 'What is the point of all this fancy research? All these babies need is food and tender loving care'. However, it was this research done at TMRU that laid the foundations for the effective treatment of severe childhood malnutrition.

Mike Golden summed it up (4): 'The studies in TMRU are bearing fruit in a very dramatic way in Africa. If the mortality rate had remained at about 30 per cent in those countries with national protocols and for those children treated by non-governmental organizations, then about one million more children would have died… The progress in understanding malnutrition and applying the lessons to practical solutions in the field has been remarkable. It would not have happened without TMRU and its successive generations of dedicated scientists'.

By his seminal contributions to human nutrition, through the visionary establishment of the Tropical Metabolism Research Unit producing distinguished alumnae and their scientific output, and through his influence on the Caribbean Health Research Council with its impact on governments and Caribbean research culture, John Waterlow has left the Caribbean and the world an unparalleled legacy.

Notes

1. Waterlow JC. 'The origin and early days of the TMRU'. In: The Tropical Metabolism Research Unit, The University of the West Indies, Jamaica, 1956-2006, The House that John Built, eds. Forrester T, Picou D, Walker S. Kingston, Ian Randle, 2007, pages 1-10.
2. Picou D, Walrond E. 'The impact of the Tropical Metabolism Research Unit on the Caribbean Health Research Council'. In: The Tropical Metabolism Research Unit, The University of the West Indies, Jamaica, 1956-2006, The House that John Built, eds. Forrester T, Picou D, Walker S. Kingston, Ian Randle, 2007, pages 298-320.
3. Walrond E, in The Commonwealth Caribbean Medical Research Council, 1956-1995, A History. Trinidad and Tobago, Commonwealth Caribbean Medical Research Council, 1995.
4. Golden M. 'A scientific journey from theory to practice: the Tropical Metabolism Research Unit' in The Tropical Metabolism Research Unit, The University of the West Indies, Jamaica, 1956-2006, The House that John Built, eds. Forrester T, Picou D, Walker S. Kingston, Ian Randle, 2007, pages 267-284.